Anti-vascular endothelial growth factor pharmacotherapy for age-related macular degeneration: a report by the American Academy of Ophthalmology.
OBJECTIVE
To examine the evidence about the safety and efficacy of anti-vascular endothelial growth factor (VEGF) pharmacotherapies for the treatment of neovascular age-related macular degeneration (AMD).


METHODS
Literature searches were conducted in May and October 2007 in PubMed with no date restrictions, limited to articles published in English, and in the Cochrane Central Register of Controlled Trials without a language limitation and yielded 310 citations. The first author reviewed the abstracts of these articles and selected 73 articles of possible clinical relevance for review by the panel. The panel deemed 64 of these articles sufficiently clinically relevant to review in full text and assigned ratings of level of evidence to each of the selected articles with the guidance of the panel methodologists.


RESULTS
Eleven studies provided level I evidence for intravitreal pegaptanib and ranibizumab for neovascular AMD; there were no studies rated level I for bevacizumab for neovascular AMD. Five studies were rated as level II, which included studies of ranibizumab and bevacizumab, and the remaining 38 articles retrieved were rated as level III. The studies do not provide information about long-term results or the value (comparative effectiveness) and cost-effectiveness of combined therapies.


CONCLUSIONS
Review of the available literature to date suggests that anti-VEGF pharmacotherapy, delivered by intravitreal injection, is a safe and effective treatment for neovascular AMD for up to 2 years. There is level I evidence to support this conclusion for pegaptanib and ranibizumab, but none for bevacizumab at this time.
Ip
Michael S
MS
American Academy of Ophthalmology, Box 7424, San Francisco, CA 94120, USA.
Scott
Ingrid U
IU
Brown
Gary C
GC
Brown
Melissa M
MM
Ho
Allen C
AC
Huang
Suber S
SS
Recchia
Franco M
FM
D000047:Academies and Institutes / Q000458:organization & administration; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide / Q000009:adverse effects / Q000627:therapeutic use*; D000068258:Bevacizumab; D020256:Choroidal Neovascularization / Q000188:drug therapy*; D004358:Drug Therapy; D006801:Humans; D008268:Macular Degeneration / Q000188:drug therapy*; D000069579:Ranibizumab; D013673:Technology Assessment, Biomedical; D016896:Treatment Outcome; D014481:United States; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D052157:Aptamers, Nucleotide; D042461:Vascular Endothelial Growth Factor A; C495058:pegaptanib; D000068258:Bevacizumab; D000069579:Ranibizumab